Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6361007624 | MI |
N | 103G00000X | Clinical Psychologist | 6301017432 | MI |
N | 103TC0700X | Clinical Psychologist | 6301017432 | MI |
NPI | 1184079394 |
---|---|
Provider Name | Allante R'reale Burnell |
First Address | Novi, MI 48377-2903 |
Second Address | Novi, MI 48377-2903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2016 |
Last Update Date | 30/07/2021 |